Ramadan Challenges: Fasting Against Medical Advice

Document Type : Review Article


1 Clinical Professor, UAE University, Endocrine Consultant, Tawam Endocrine Diabetes Center, SEHA, UAE

2 Endocrine Consultant, Tawam Endocrine Diabetes Center, SEHA, UAE

3 Honorary Professor, Institute of Public Health, UAE University


Introduction: Fasting against medical advice (FAMA) is a major challenge for many physicians who treat patients with diabetes during the month of Ramadan. The significance of this phenomenon has not been evaluated in Muslim populations. The goal of this study was to assess the rate and consequences of FAMA in our high-risk patients. Methods: This is a retrospective case-control study. Patients were divided into two groups: (Group A) included high risk patients who decided to fast against the advice of their health care providers, and (Group B) included the low risk patients who were permitted to fast. Results: A total of 401 patients were evaluated. Out of the whole group, 147 patients were categorized as high risk for fasting. (Group A) included 111/147 patients who decided to fast against medical advice and (Group B) included 254 patients permitted to fast. The average number of fasted days and the proportion of patients who were able to fast the whole month were smaller in Group A than Group B (26±3 SD and 51% versus 29±1 SD and 87%, respectively, P<0.001). Severe hypoglycemia was significantly higher in Group A than group B (63% and 50% respectively, P=0.039). Conclusions: The majority of our high-risk patients elect to observe fasting in the month of Ramadan against the advice of their medical team. Patients who insisted on fasting against medical advice were more likely to break their fast due to hypoglycemia or other causes.


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